Editor’s reaction to acid attacks in London

14 July 2017
| Andrew Burd (Prof)

As I travelled to work to day I heard on the radio that there had been five separate “acid attacks” in London last night. It appears that these were all perpetrated by the same assailants and the motivation for the attacks is still unclear. It is evident that assault with corrosive substances is becoming more common in the UK for a number of reasons; the ready access to the chemicals, the ease in which they can be carried and, if caught, the maximum charge of grievous bodily harm (GBH) associated with such attacks. This contrasts with a charge of attempted murder associated with knife attacks or the use of guns.

The evil nature of these attacks cannot be understated. The intent is to kill a person in terms of their identity, leaving them scarred for life and marginalized from society. Bangladesh had, at one time, the highest incidence of such attacks when looking at global figures. The basic motivation is one of three L’s: love, loans and land. Men, women and children are all victims. It took years of campaigning in Bangladesh to change the law and change the attitudes of the public. Acid assault is now regarded as a capital offence and there is a greater incentive to report such crimes as the police can no longer regard them with the former blind neglect. The incidence has dramatically reduced.

Attempts at registration of potentially harmful chemicals did not prove effective. It is possible to restrict access to high concentrations of certain acids, in particular sulphuric, nitric and hydrochloric acids. The widespread availability of weaker solutions, e.g. the 30-50% solutions of sulphuric acid used in car batteries make restricting access an impractical solution to this problem.

Having spent many years working with victims of acid assault and having worked in the Far East where acute acid assaults are more common it was apparent that standard first aid and acute management was not effective. In a paper published in the Indian Journal of Plastic Surgery in 2010 I proposed a more pragmatic approach. In selected cases, chemical assaults should be regarded as acute surgical emergencies with lavage supplemented by physical removal of chemical from the skin. The protocol was published in the 2010 and again in 2015. It requires assessment by an experienced burns surgeon who can perform the necessary tangential excision. I append the references to the two papers and include the protocol below.

The take home message is stark: chemical assaults are devastating in outcome and must be regarded in the same light as other capital offences; the intent is to destroy a person.

If an attack does occur then highly specialised acute management is required to decrease the damage and optimise the outcome.

Further reading

Burd A, Ahmed K. The acute management of acid assault burns: a pragmatic approach. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India 2010;43(1):29.